J Korean Neurosurg Soc.  2018 Mar;61(2):224-232. 10.3340/jkns.2017.1201.003.

Analysis of Factors Contributing to Repeat Surgery in Multi-Segments Cervical Ossification of Posterior Longitudinal Ligament

• Jeon I
• Cho YE

• KMID: 2408024
• DOI: http://doi.org/10.3340/jkns.2017.1201.003

Abstract

OBJECTIVE
Cervical ossification of the posterior longitudinal ligament (OPLL) can be treated via anterior or posterior approach, or both. The optimal approach depends on the characteristics of OPLL and cervical curvature. Although most patients can be successfully treated by a single surgery with the proper approach, renewed or newly developed neurological deterioration often requires repeat surgery.
METHODS
Twenty-seven patients with renewed or newly developed neurological deterioration requiring salvage surgery for multi-segment cervical OPLL were enrolled. Ten patients (group AP) underwent anterior approach, and 17 patients (group PA) underwent posterior approach at the initial surgery. Clinical and radiological data from initial and repeat surgeries were obtained and analyzed retrospectively.
RESULTS
The intervals between the initial and repeat surgeries were 102.80±60.08 months (group AP) and 61.00±8.16 months (group PA) (p < 0.05). In group AP, the main OPLL lesions were removed during the initial surgery. There was a tendency that the site of main OPLL lesions causing renewed or newly developed neurological deterioration were different from that of the initial surgery (8/10, p < 0.05). Repeat surgery was performed for progressed OPLL lesions at another segment as the main pathology. In group PA, the main OPLL lesions at the initial surgery continued as the main pathology for repeat surgery. Progression of kyphosis in the cervical curvature (Cobb's angle on C2-7 and segmental angle on the main OPLL lesion) was noted between the initial and repeat surgeries. Group PA showed more kyphotic cervical curvature compared to group AP at the time of repeat surgery (p < 0.05).
CONCLUSION
The reasons for repeat surgery depend on the type of initial surgery. The main factors leading to repeat surgery are progression of remnant OPLL at a different segment in group AP and kyphotic change of the cervical curvature in group PA.

Keyword

Cervical vertebrae; Ossification of posterior longitudinal ligament; Reoperation; Kyphosis

MeSH Terms

Cervical Vertebrae
Female
Humans
Kyphosis
Longitudinal Ligaments
Ossification of Posterior Longitudinal Ligament*
Pathology
Reoperation*
Retrospective Studies

Figure

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  Fig. 1 Cobb’s angle of the entire cervical curvature was measured as the angle between the lower margin of C2 and C7, and the segmental angle was defined and measured by Cobb’s method between the lines of the upper vertebral body’s upper margin and the lower vertebral body’s lower margin in the segment of interest on a static neutral position (A). Lordosis was recorded as a positive value, and kyphosis was recorded as a negative value. The ossification of the posterior longitudinal ligament (OPLL) occupying ratio was calculated as the maximum thickness of the OPLL to the anterior–posterior diameter of the spinal canal at the main OPLL lesion on computed tomography scan (b/a) (B). In case of loss of the anterior or posterior structure of the spinal canal at the main OPLL lesion during initial surgery, the boundary of the dural sac anteriorly or posteriorly on T2 weighted image was regarded as the extent of the diameter (d/c) (C).

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  Fig. 2 Case 1 (group AP). A male patient, 55 years of age, complained myelopathy including gait disturbance and clumsy hand due to OPLL of C3–5. The symptoms were recovered completely after anterior cervical corpectomy and fusion on C3–5 with corpectomy of C4 (A). He presented of newly developed myelopathy originating from OPLL of C2–3 after 65.5 months (B). Laminoplasty on C3–6 with partial laminectomy of lower C2 was performed, the newly developed symptom disappeared with remaining mild shoulder pain (C and D). OPLL : ossification of the posterior longitudinal ligament.

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  Fig. 3 Case 2 (group PA). A male patient, 59 years of age, underwent laminectomy alone on C3–6 for OPLL of C3–6 causing myelopathy including gait disturbance and numbness of both arms (A). The symptoms was relieved and maintained for 30 months. However, he presented of gait disturbance and weakness of upper limbs again. The OPLL lesion of C4–5 continued as the main pathology causing initial myelopathy and newly developed symptoms with a progression of cervical kyphosis (the entire cervical Cobb’s angle from 1.9 to -9.0) (B). Anterior cervical corpectomy and fusion on C3–5 with corpectomy of total C4 and upper C5 removing main OPLL lesion was performed, the patient shows improved gait disturbance with slight weakness of both hand grip (C and D). OPLL : ossification of the posterior longitudinal ligament; lordosis was recorded as a positive value, and kyphosis was recorded as a negative value.

Reference

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